- Theruvath, Johanna;
- Menard, Marie;
- Smith, Benjamin AH;
- Linde, Miles H;
- Coles, Garry L;
- Dalton, Guillermo Nicolas;
- Wu, Wei;
- Kiru, Louise;
- Delaidelli, Alberto;
- Sotillo, Elena;
- Silberstein, John L;
- Geraghty, Anna C;
- Banuelos, Allison;
- Radosevich, Molly Thomas;
- Dhingra, Shaurya;
- Heitzeneder, Sabine;
- Tousley, Aidan;
- Lattin, John;
- Xu, Peng;
- Huang, Jing;
- Nasholm, Nicole;
- He, Andy;
- Kuo, Tracy C;
- Sangalang, Emma RB;
- Pons, Jaume;
- Barkal, Amira;
- Brewer, Rachel E;
- Marjon, Kristopher D;
- Vilches-Moure, Jose G;
- Marshall, Payton L;
- Fernandes, Ricardo;
- Monje, Michelle;
- Cochran, Jennifer R;
- Sorensen, Poul H;
- Daldrup-Link, Heike E;
- Weissman, Irving L;
- Sage, Julien;
- Majeti, Ravindra;
- Bertozzi, Carolyn R;
- Weiss, William A;
- Mackall, Crystal L;
- Majzner, Robbie G
The disialoganglioside GD2 is overexpressed on several solid tumors, and monoclonal antibodies targeting GD2 have substantially improved outcomes for children with high-risk neuroblastoma. However, approximately 40% of patients with neuroblastoma still relapse, and anti-GD2 has not mediated significant clinical activity in any other GD2+ malignancy. Macrophages are important mediators of anti-tumor immunity, but tumors resist macrophage phagocytosis through expression of the checkpoint molecule CD47, a so-called 'Don't eat me' signal. In this study, we establish potent synergy for the combination of anti-GD2 and anti-CD47 in syngeneic and xenograft mouse models of neuroblastoma, where the combination eradicates tumors, as well as osteosarcoma and small-cell lung cancer, where the combination significantly reduces tumor burden and extends survival. This synergy is driven by two GD2-specific factors that reorient the balance of macrophage activity. Ligation of GD2 on tumor cells (a) causes upregulation of surface calreticulin, a pro-phagocytic 'Eat me' signal that primes cells for removal and (b) interrupts the interaction of GD2 with its newly identified ligand, the inhibitory immunoreceptor Siglec-7. This work credentials the combination of anti-GD2 and anti-CD47 for clinical translation and suggests that CD47 blockade will be most efficacious in combination with monoclonal antibodies that alter additional pro- and anti-phagocytic signals within the tumor microenvironment.